2011-11-09T15:46:11-06:00 2010-12-31 LARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-01-01 560529976 GRACE HOSPITAL INC GRAC 8285805000 2201 SOUTH STERLING STREET MORGANTON NC 28655 ROBERT G FRITTS 8285805000 2011-11-09 1 GREGORY W JOHNS 7049985200 2010 2016-02-24 21:20:13Z KENNETH W WOOD 2201 SOUTH STERLING STREET MORGANTON NC 28655 132384083 0 X WWW.BLUERIDGEHEALTH.ORG X 1906 NC IMPROVING THE HEALTH OF OUR COMMUNITIES BY PROVIDING EXCELLENT AND COMPASSIONATE CARE. 15 13 1107 86 1498668 0 731347 588840 103963451 106468654 -2647539 3501698 2414308 2759811 104461567 113319003 55525 273479 0 0 43004100 43680548 0 0 0 64564432 65221334 107624057 109175361 -3162490 4143642 197138382 198574101 77262947 69545712 119875435 129028389 GRACE HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITIES BY PROVIDING EXCELLENT AND COMPASSIONATE CARE. 0 0 15693863 15296623 GRACE HOSPITAL PROVIDED 24,026 DAYS OF CARE TO 6,223 PATIENTS ADMITTED. GRACE HOSPITAL HAS 184 BEDS AND OFFERS A BROAD SCOPE OF SERVICES. 12669368 20804247 GRACE HOSPITAL'S SURGICAL SERVICES PERFORMED 1,450 INPATIENTS SURGERIES AND 3,911 OUTPATIENT SURGERIES. ORTHOPEDICS, GENERAL SURGERY, SPINE SURGERY, AND OB/GYN ARE THE MAJOR SURGICAL SPECIALITIES OFFERED. 4847513 13013816 EMERGENCY ROOM SAW 38,226 PATIENTS DURING THE YEAR. THE ED IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK AND IS ABLE TO TAKE CARE OF ANY TYPE OF EMERGENCY OR PROBLEM. 58281478 58127461 58281478 58127461 91492222 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 1107 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 NC X PATRICIA MOLL 8285805000 2201 SOUTH STERLING STREET MORGANTON NC 28655 X KENNETH W WOOD 40.00 X X 0 0 0 J MICHAEL BRIDGES 1.00 X 0 0 0 MH MCCRARY 1.00 X 0 0 0 JAMES ROSTAN 1.00 X 0 0 0 JEFF CARSWELL 1.00 X 0 0 0 PHILIP TATE 1.00 X 0 0 0 CLAY RICHARDSON MD 1.00 X 0 0 0 KENNETH BONFIELD MD 1.00 X 0 406 0 S ANDREWS DEEKENS MD 1.00 X 0 0 0 LISA BUFF 1.00 X 0 0 0 JOHN BRANSTROM 1.00 X 0 0 0 DORIS FULLWOOD 1.00 X 0 0 0 SHERROD SALSBURY III 1.00 X 0 0 0 ALAN GRIFFIN 1.00 X 0 0 0 ALLEN VANNOPPEN 1.00 X 0 0 0 JAY STOCK 1.00 X 0 0 0 CRAIG RICHARDVILLE 1.00 X 0 0 0 JOHN YOUNG 1.00 X 0 0 0 ROBERT G FRITTS 40.00 X 0 0 0 KATHY BAILEY 40.00 X 0 0 0 LAURA LAMBETH 40.00 X 240736 0 30260 THOMAS EURE 40.00 X 180521 0 53257 ANTHONY FRASCA MD 40.00 X 240385 0 40760 BYRON STROTHER MD 40.00 X 250000 0 45517 KENNETH GALLOWAY 40.00 X 246320 0 41845 1157962 406 211639 21 0 1 0 NURSE ANESTHESIA OF NORTH CAROLINA PO BOX 6633 HIGH POINT NC 28277 CRNA STAFFING 2162918 DAVID E LOOPER & COMPANY 320 15TH STREET SOUTHEAST HICKORY NC 28602 GENERAL CONTRACTORS 1286655 ARAMARK CTS 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 FACILITIES SERVICE MANAGEMENT 1201636 ENDURACARE THERAPY MANAGEMENT DEPT AT 952922 GEMINO HC ATLANTA GA 31192 REHABILITATION THERAPY SERVICES 1169318 ARAMARK FACILITIES 22506 NETWORK PLACE CHICAGO IL 60673 FACILITIES SERVICES MANAGEMENT 675716 17 588840 588840 PATIENT REVENUE 621400 100745767 100745767 INTER-FACILITY REVENUE 621400 9351359 9351359 INTEGRATION OPERATING 900099 -4968463 -4968463 1339991 1339991 106468654 2359885 2359885 486128 486128 486128 486128 20206893 19065080 1141813 1141813 1141813 UNRELATED BUSINESS INC 624110 1498668 1498668 GUILD 900099 66012 66012 INTEGRATION CAPITAL 900099 -7970 -7970 716973 716973 2273683 113319003 107243669 1498668 3987826 273479 273479 271121 271121 37128734 26628261 10500473 281744 203070 78674 3689866 2652050 1037816 2309083 1664295 644788 179714 179714 82800 82800 179931 179931 13380238 12283009 1097229 962124 962124 180270 180270 1861836 1861836 353680 353680 2430592 2430592 7921209 7921209 2344520 2344520 BAD DEBT 17990426 17990426 SUPPLIES 9674898 9674898 DIETARY COSTS 3146508 3146508 INTERCOMPANY 1807704 1807704 EQUIP/MAINT 1111729 1111729 1613155 1218355 394800 109175361 91492222 17683139 0 1385997 597214 3662251 3484324 16784978 15260567 16812718 15247732 1293628 1701514 680109 435877 173354218 93995736 83756175 79358482 13041742 15961988 59720784 66526403 197138382 198574101 6468868 7897960 354753 13455000 32257290 4778762 1628670 52205564 27761792 77262947 69545712 X 119790000 128998053 85435 30336 119875435 129028389 197138382 198574101 X 4143642 5009312 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9937 9937 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: MEMBERSHIP DUES TO AMERICAN HOSPITAL ASSOCIATION ($1,722) AND NORTH CAROLINA HEALTH CARE FACILITIES ASSOCIATION ($8,215). 977206 977206 102267652 55765691 46501961 65701838 35826660 29875178 4407522 2403385 2004137 79358482 INVESTMENTS 15961988 F 15961988 OTHER ASSETS 1229135 BOARD DESIGNATED FOR SCHOLARSHIPS 129338 BOARD DESIGNATED AS FUNDED DEPRECIATION 65058704 GUILD 109226 66526403 DUE TO BLUE RIDGE HEALTH SYSTEMS, INC. 24523974 THIRD PARTY SETTLEMENTS 3236961 GUILD 857 27761792 113319003 109175361 4143642 5010396 -1084 5009312 9152954 116930577 5010396 -950451 4059945 112870632 448371 448371 113319003 107763729 -382359 -382359 108146088 1029273 1029273 109175361 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FILING ORGANIZATION IS A TAX-EXEMPT ORGANIZATION AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE FILING ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE FILING ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE FILING ORGANIZATION ADOPTED THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THIS STANDARD HAD NO IMPACT ON THE FILING ORGANIZATION'S FINANCIAL STATEMENTS FOR THE YEARS ENDED DECEMBER 31, 2010 OR DECEMBER 31, 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: MISCELLANEOUS -1,084. PART XII, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT FEES -179,931. RECLASSED EXPENSES -825,619. RELEASES FROM RESTRICTION 55,099. PART XII, LINE 4B - OTHER ADJUSTMENTS: GUILD 66,012. DISTRIBUTIONS-PARTNERSHIPS 382,359. RENTAL EXPENSES PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES DISTRIBUTIONS-PARTNERSHIPS -382,359. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RECLASSED EXPENSES 825,619. INVESTMENT FEES 179,931. GUILD 23,723. 1 1 X 1 X 1 X 180.000000000000 1 1 1 0 1 1 2321811 1918839 402972 0.00440 16384118 11188230 5195888 0.05700 430536 313479 117057 0.00130 19136465 13420548 5715917 0.06270 129626 129626 0.00140 41298 41298 0.00050 236282 236282 0.00260 407206 407206 0.00450 19543671 13420548 6123123 0.06720 0 5710712 1097516 25734431 27464449 -1730018 X 1 1 1 BLUE RIDGE CARDIOLOGY HEART CATH SVCS 0.50000 3 CAROLINAS HEALTHCARE SYSTEM MANAGEMENT SERVICES 0.00000 4 CHS - HEALTHY HOME HOME NURSING & THERAPY 0.18000 1 1 GRACE HOSPITAL INC

2201 SOUTH STERLING STREET MORGANTON NC 28655

X X X NOT REQUIRED 1 0 0 0 0 0 0 0 0 0 0 0 PART I, LINE 3C: GRACE HOSPITAL USES THE SLIDING SCALE PROVIDED IN THE FEDERAL POVERTY INCOME GUIDELINES PUBLISHED ANNUALLY BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO DETERMINE ELIGIBILITY. AN ASSET TEST IS USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. PART I, LINE 6A: COMMUNITY BENEFIT REPORT IS PREPARED FOR BLUE RIDGE HEALTHCARE SYSTEM (BRHS) WHICH INCLUDES GRACE HOSPITAL AND VALDESE GENERAL HOSPITAL. PART I, L7 COL(F): BAD DEBT COST FROM LINE 2 IS BASED ON TOTAL BAD DEBT EXPENSE MULTIPLIED BY THE COST-TO-CHARGE RATIO. CHARITY INCLUDED ON LINE 3 IS CALCULATED BASED ON A STATISTICAL SAMPLE OF SELF PAY PATIENTS THAT QUALIFY FOR CHARITY CARE FROM THE OUTPATIENT SETTING. PER NOTE 8 OF BLUE RIDGE'S AUDITED FINANCIAL STATEMENTS, "UNINSURED DISCOUNTS AND BAD DEBTS - INCLUDES THE COST OF SERVICES PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS AND TO PATIENTS WHO OTHERWISE DO NOT PAY FOR THEIR HEALTHCARE SERVICES." PART II: NOT APPLICABLE FOR GRACE HOSPITAL. PART III, LINE 4: THE MISSION OF BRHS IS TO CREATE AND OPERATE A HEALTH SYSTEM TO PROVIDE HOSPITAL, ACUTE AND EMERGENCY CARE, INPATIENT PSYCHIATRIC SERVICES, PHYSICIAN SERVICES, LONG-TERM CARE AND HOME HEALTH SERVICES FOR THE BENEFIT OF THE COMMUNITY IT SERVES. COMMITMENT TO THIS MISSION REQUIRES BOTH AN INVESTMENT IN AND A PARTNERSHIP WITH THE COMMUNITY WITHIN WHICH BRHS OPERATES. BRHS DEFINES AND MEASURES THIS INVESTMENT IN AND PARTNERSHIP WITH THE COMMUNITY USING THE FOLLOWING CATEGORIES OF COMMUNITY BENEFIT:CHARITY CARE - INCLUDES THE COST OF SERVICES PROVIDED TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER BRHS CHARITY CARE POLICY. KEY ELEMENTS USED TO DETERMINE ELIGIBILITY FOR CHARITY CARE INCLUDE A PATIENTS DEMONSTRATED ABILITY TO PAY BASED ON FAMILY SIZE AND HOUSEHOLD INCOME RELATIVE TO FEDERAL INCOME POVERTY GUIDELINES. UNINSURED DISCOUNTS AND BAD DEBTS INCLUDES THE COST OF SERVICES PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS AND TO PATIENTS WHO OTHERWISE DO NOT PAY FOR THEIR HEALTHCARE SERVICES.UNFUNDED MEDICARE AND MEDICAID REPRESENTS THE UN-REIMBURSED COST OF SERVICES PROVIDED TO PATIENTS WHO QUALIFY FOR FEDERAL AND-OR STATE GOVERNMENT HEALTHCARE BENEFITS. COMMUNITY BENEFIT PROGRAMS INCLUDES THE UN-REIMBURSED COST OF VARIOUS EDUCATION AND RESEARCH PROGRAMS, NON-BILLED MEDICAL SERVICES, IN-KIND DONATIONS, AND OTHER SERVICES THAT MEET A STRONG COMMUNITY NEED, BUT DO NOT PAY FOR THEMSELVES. EXAMPLES OF THESE COMMUNITY BENEFIT PROGRAMS INCLUDE ACTIVITIES THAT PROMOTE DISEASE DETECTION AND PREVENTION (FREE HEALTH SCREENINGS, EDUCATION AND INFORMATION), WORK FORCE TRAINING (PARTNERSHIPS WITH AREA COMMUNITY COLLEGES AND UNIVERSITIES), ECONOMIC DEVELOPMENT AND DONATIONS TO COMMUNITY-BASED HEALTH AND HUMAN SERVICES ORGANIZATIONS WHOSE MISSIONS COMPLEMENT THE MISSION OF BRHS. PART III, LINE 8: THE MEDICARE COST REPORT IS PREPARED USING THE AUDITED TRIAL BALANCE FOR GRACE HOSPITAL. THE COST REPORT IS PREPARED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS. AS A 501(C)(3) ORGANIZATION, GRACE HOSPITAL ACCEPTS ALL PATIENTS WITHOUT REGARD TO THE INSURANCE OR LACK OF INSURANCE. PART III, LINE 9B: ALL SELF PAY E.D. PATIENTS ARE SCREENED FOR CHARITY AND-OR FINANCIAL ASSISTANCE IN THE E.D. AREA. PATIENT SEEN IN OUTPATIENT SURGERY AND INPATIENT SETTINGS ARE SCREENED DURING OR PRIOR TO SERVICES. MONTHLY STATEMENTS REFERENCE THE PHONE NUMBERS TO CALL FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: GRACE HOSPITAL PERFORMS OUTREACH SERVICES AND HEALTH EDUCATION OPPORTUNITIES FOR THE COMMUNITY SERVED. FEEDBACK FROM THESE EFFORTS ALONG WITH THE EVALUATION OF THE PATIENTS SERVED ARE CONSIDERED IN ASSESSING THE COMMUNITIES HEALTH CARE NEEDS. IN ADDITION, THE ORGANIZATION HAS CONDUCTED EXTENSIVE RESEARCH INTO THE AREAS MOST SERIOUS HEALTH THREATS AND DEVELOPED A PLAN TO FOCUS ATTENTION ON THESE ISSUES. PART VI, LINE 3: ALL SELF PAY ED PATIENTS ARE SCREENED FOR CHARITY AND-OR FINANCIAL ASSISTANCE IN THE ED AREA. PATIENT SEEN IN OUTPATIENT SURGERY AND INPATIENT SETTINGS ARE SCREENED DURING OR PRIOR TO SERVICES. MONTHLY STATEMENTS REFERENCE THE PHONE NUMBERS TO CALL FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: BRHCS PRIMARY SERVICE AREA INCLUDES THREE COUNTIES (BURKE, MCDOWELL, CALDWELL); PATIENTS FROM A NUMBER OF OTHER OUTLYING COUNTIES ARE ALSO SERVED BY BRHC. THE POPULATION IS PREDOMINANTLY CAUCASIAN. SIGNIFICANT MINORITIES INCLUDE HMONG, AFRICAN-AMERICAN AND HISPANIC RESIDENTS. THE AREA IS ECONOMICALLY DEPRESSED DUE TO THE LOSS OF TRADITIONAL FURNITURE AND TEXTILE INDUSTRIES. PART VI, LINE 6: BRHC IS GOVERNED BY A VOLUNTEER COMMUNITY BOARD OF DIRECTORS. BRHC SYSTEM IS SERVED BY OPEN MEDICAL STAFFS. THE SYSTEM IS ALSO SUPPORTED BY A GROWING BRHC VOLUNTEERS CORPS WHO CONTRIBUTE THOUSANDS OF HOURS IN SERVICE ANNUALLY. BRHC ACTIVELY RECRUITS PRIMARY CARE PHYSICIANS AND PHYSICIAN SPECIALISTS TO MEET SPECIFIC MEDICAL NEEDS IN THE COMMUNITY. PART VI, LINE 7: GRACE HOSPITAL IS PART OF BLUE RIDGE HEALTHCARE SYSTEM. BLUE RIDGE SERVES BURKE COUNTY, NC AND SURROUNDING COUNTIES. BLUE RIDGE IS AFFILIATED WITH CAROLINAS HEALTHCARE SYSTEM BASED IN CHARLOTTE, NC. REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 BLUE RIDGE HEALTHCARE FOUNDATION INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 582063920 501(C)(3) 24300 MEMORIAL DONATIONS AND HEALTHCARE EQUIPMENT BURKE CO - FOOTHILLS ALLIED HEALTH PO BOX 219 MORGANTON NC 28655 566000280 501(C)(3) 37800 DONATION FOR HEALTHCARE EDUCATION CENTER GOOD SAMARITAN CLINIC 305 W UNION ST MORGANTON NC 28655 561939030 501(C)(3) 50000 RETAIL VALUE DONATED PHARMACEUTICALS BURKE COUNTY COMMITTEE OF 100 INC PO BOX 1489 MORGANTON NC 28655 208831851 501(C)(3) 5000 COMMUNITY BENEFIT BURKE COUNTY PUBLIC SCHOOLS PO BOX 889 MORGANTON NC 28655 560935935 GOVERNMENTAL 156379 SCHOOL NURSES AND ATHLETIC TRAINERS 4 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: BLUE RIDGE HEALTHCARE SYSTEM EMPLOYEES AND THEIR FAMILY MEMBERS ARE FIRST CONSIDERED FOR FINANCIAL ASSISTANCE THROUGH SCHOLARSHIPS AND GRANTS IN AID. APPLICANTS PREPARING FOR WORK IN HEALTHCARE RELATED AREAS ARE CONSIDERED NEXT. GENERALLY, THIS DOES NOT INCLUDE AREAS OF STUDY SUCH AS ACCOUNTING OR INFORMATION SYSTEMS. FINANCIAL ASSISTANCE IS BASED ON THE INDIVIDUAL'S QUALIFICATIONS AND DEMONSTRATED FINANCIAL NEEDS. A GRADE POINT AVERAGE OF AT LEAST 2.5 ON A 4.0 SCALE IS REQUIRED. THE SCHOLARSHIP COMMITTEE MEETS TWICE A YEAR OR AS OFTEN AS NEEDED TO DECIDE ON RECIPIENTS. IF ALL APPLICATIONS SATISFY SELECTION CRITERIA, THEN MONIES ARE AWARDED BASED ON OTHER FINANCIAL ASSISTANCE AWARDED, DEMONSTRATED FINANCIAL NEED, AREA OF STUDY, AND GRADE POINT AVERAGE. ALL SELECTED APPLICATIONS INTERVIEWED BY THE SCHOLARSHIP COMMITTEE CHAIRPERSON. X 1 1 X X X X 0 0 0 0 0 1 1 0 0 LAURA LAMBETH 184682 0 56054 0 0 0 11390 0 18870 0 270996 0 0 0 THOMAS EURE 153185 0 25581 0 1755 0 12497 0 40760 0 233778 0 0 0 ANTHONY FRASCA MD 240385 0 0 0 0 0 0 0 40760 0 281145 0 0 0 BYRON STROTHER MD 250000 0 0 0 0 0 4617 0 40900 0 295517 0 0 0 KENNETH GALLOWAY 245551 0 0 0 769 0 1010 0 40835 0 288165 0 0 0 PART I, LINE 6 BONUSES ARE PAID IF THE ORGANIZATION'S RESULTS MEET CERTAIN PERFORMANCE INDICATORS. SUPPLEMENTAL INFORMATION PART III PART II: COMPENSATION FOR KENNETH WOOD, KATHY BAILEY, AND ROBERT FRITTS IS PAID BY CAROLINA HEALTH SYSTEMS THROUGH A MANAGEMENT SERVICE CONTRACT. KENNETH WOOD VOTING BOARD MEMBER AND CEO HIS COMPENSATION IS PAID BY CAROLINA HEALTH SYSTEM 0 FORM 990, PART VI, SECTION A, LINE 3 IN 1999, THE ORGANIZATION ENTERED INTO A MANAGEMENT SERVICES CONTRACT WITH CAROLINAS HEALTHCARE SYSTEM. THE TERMS OF THE CONTRACT CALL FOR THE ORGANIZATION TO PAY CAROLINAS HEALTHCARE SYSTEM AN ANNUAL MANAGEMENT FEE BASED UPON THE ORGANIZATION'S NET OPERATING REVENUES. IN ADDITION, CAROLINAS HEALTHCARE SYSTEM IS REQUIRED TO FURNISH THE ORGANIZATION WITH A CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, AND CHIEF FINANCIAL OFFICER. THE ORGANIZATION REIMBURSES CAROLINAS HEALTHCARE SYSTEM FOR THE SALARY AND BENEFITS' COST OF THESE INDIVIDUALS. SEE SCHEDULE J PART III FOR DETAILS OF THE SALARY AND BENEFITS. FORM 990, PART VI, SECTION B, LINE 11 THE CHIEF FINANCIAL OFFICER AND THE EXECUTIVE COMMITTEE WILL REVIEW THE PREPARED FORM 990 BEFORE IT IS FILED WITH THE IRS. A DRAFT OF FORM 990 WILL BE EMAILED TO EACH MEMBER OF THE GOVERNING BODY BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CORPORATE COUNSEL, WHO REVIEWS ALL ANNUAL CONFLICT OF INTEREST DISCLOSURES, IS PRESENT AT EVERY BOARD MEETING TO ENSURE THAT ANY POTENTIAL CONFLICTS ARE APPROPRIATELY HANDLED BY MEMBERS ABSTAINING FROM VOTES AS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 SUCH A PROCESS WAS PERFORMED FOR DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT/CEO, CFO AND AND COO DURING 2010 AND KEY EMPLOYEE DURING 2010. FORM 990, PART VI, SECTION C, LINE 19 BY-LAWS ARE AVAILABLE UPON REQUEST THROUGH CORPORATE COUNSEL. ARTICLES OF INCORPORATION ARE FILED WITH NC STATE AND ARE AVAILABLE ON THEIR WEBSITE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS: OFFICERS AND KEY EMPLOYEES LISTED ON PART VII WORK AN AVERAGE OF 40 HOURS PER WEEK. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND OTHER RELATED ENTITIES LISTED ON SCHEDULE R. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 5,010,396. MISCELLANEOUS -1,084. TOTAL TO FORM 990, PART XI, LINE 5: 5,009,312. FORM 990, PART XII, LINE 2C: NO CHANGES FOR APPROVING AUDITED FINANCIAL STATEMENTS OR SELECTION OF INDEPENDENT ACCOUNTANTS HAVE OCCURRED FROM THE PRIOR YEAR. GRACE HEALTH VENTURES INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 561581317 RELATED NC -869 35797 BLUE RIDGE HEALTHCARE SYSTEMS INC VALDESE GENERAL HOSPITAL INC 720 MALCOLM BOULEVARD VALDESE NC 28690 560634510 HEALTHCARE NC 501 (C)(3) N/A N/A 0 VALDESE NURSING HOME INC 95 LOCUST STREET RUTHERFORD COLLEGE NC 28671 561978560 HEALTHCARE NC 501 (C)(3) 509(A)(2) N/A 0 GRACE LIFECARE INC 500 LENOIR ROAD MORGANTON NC 28655 561722754 HEALTHCARE NC 501 (C)(3) 509(A)(2) N/A 0 GRACE NURSING CENTER INC 109 FOOTHILLS DRIVE MORGANTON NC 28655 561838369 HEALTHCARE NC 501 (C)(3) 509(A)(2) N/A 0 GRACE PROPERTIES INC 500 LENOIR ROAD MORGANTON NC 28655 561727514 HEALTHCARE NC 501 (C)(3) 509(A)(3) N/A 0 BLUE RIDGE FOUNDATION INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 582063920 HEALTHCARE NC 501 (C)(3) 509(A)(1) N/A 0 BLUE RIDGE MEDICAL GROUP INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 020777195 HEALTHCARE NC 501 (C)(3) 509(A)(2) N/A 0 BLUE RIDGE HEALTHCARE SYSTEMS INC 2201 SOUTH STERLING STREET MORGANTON NC 28655 562150313 HEALTHCARE NC 501 (C)(3) 509(A)(3) N/A 0 BLUE RIDGE MOBILE IMAGING LLC 2201 SOUTH STERLING STREET MORGANTON NC 28655 020777199 HEALTHCARE NC 501 (C)(3) N/A N/A 0 BLUE RIDGE CARDIOLOGY 2201 SOUTH STERLING STREET MORGANTON NC 28655 753158601 CARDIAC CATHETERIZATION SERVICES NC BRHC & MEDCATH RELATED -16581 364134 0 0 0.50000 HEALTHY HOME LLC 4425 GOLF ACRES DR CHARLOTTE NC 29202 261451047 HOME HEALTH SERVICES NC THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY RELATED 312 1051608 0 0 0.18000 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 GRACE LIFECARE INC P 348636 INTERCOMPANY ACTIVITY BLUE RIDGE MEDICAL GROUP INC P 220373 INTERCOMPANY ACTIVITY BLUE RIDGE MEDICAL GROUP INC J 489573 INTERCOMPANY ACTIVITY BLUE RIDGE CARDIOLOGY L 1779357 INTERCOMPANY ACTIVITY BLUE RIDGE HEALTHCARE SYSTEMS INC O 3432297 INTERCOMPANY ACTIVITY